E3 PreliminaryPreliminaryPEM unclearCase-ControlPeer-reviewedMachine draft
Psychological stress contributed to the development of low-grade fever in a patient with chronic fatigue syndrome: a case report.
Oka, Takakazu, Kanemitsu, Yoshio, Sudo, Nobuyuki et al. · BioPsychoSocial medicine · 2013 · DOI
Quick Summary
This study followed one ME/CFS patient who noticed her low-grade fevers got worse during stressful work situations. Researchers had her recall stressful memories while measuring her body temperature and stress hormones. Her core temperature rose by about 1°C during stress, but blood markers related to fever-causing inflammation didn't change, suggesting stress hormones (not immune inflammation) triggered the temperature increase.
Why It Matters
Low-grade fever affects many ME/CFS patients but remains poorly explained. This case suggests that psychological stress may trigger temperature elevation through sympathetic nervous system activation rather than classic immune inflammation, potentially opening new avenues for understanding and managing this symptom.
Observed Findings
- Axillary temperature increased from 37.2°C to 38.2°C (1.0°C rise) during a 60-minute stress interview
- Fingertip temperature paradoxically decreased during stress despite core temperature rise
- Plasma catecholamine levels (noradrenaline and adrenaline) increased significantly during the interview
- Heart rate and systolic/diastolic blood pressures increased during stress
- No significant changes were detected in pyretic cytokines (IL-1β, IL-6) or antipyretic cytokines (TNF-α, IL-10)
Inferred Conclusions
- Psychological stress-induced hyperthermia in this CFS patient was mediated by sympathetic nervous system activation rather than pyretic cytokine production
- Negative emotion and sympathetic activation may contribute to development or exacerbation of low-grade fever in some CFS patients
- The divergence between core and peripheral temperature suggests stress-induced vasoconstriction and central temperature dysregulation
Remaining Questions
- Does this sympathetic mechanism apply to low-grade fever in other CFS patients, or is this pattern idiosyncratic to this individual?
- What role do other immune markers or thermoregulatory mechanisms play in stress-induced fever in CFS?
What This Study Does Not Prove
This single-case report does not establish that psychological stress causes fever in all or most CFS patients—findings may not generalize beyond this one individual. The study shows correlation between stress and temperature changes, not definitive causation, and cannot rule out other physiological mechanisms operating in different patients. The lack of cytokine changes does not prove they are never involved in CFS fever.
Tags
Symptom:FatigueTemperature Dysregulation
Biomarker:CytokinesBlood Biomarker
Method Flag:Weak Case DefinitionNo ControlsSmall SampleExploratory Only
Metadata
- DOI
- 10.1186/1751-0759-7-7
- PMID
- 23497734
- Review status
- Machine draft
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 8 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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